Fact Vs Process

Learning By Instantiation

• The use of carefully selected examples is an important principle in learning clinical reasoning.
  • Learning from examp[es certainly is not new in medicine.
  • For years, we have taught clinical facts by exposing students to many different examples of the same kind of clinical problem (such as [[Jaundice]] or [[Acute [[Renal Failure]]]]) because comprehension of clinical entities is enriched by repeated exper ience with specific instances of these entit ies.
  • In the cases provided in Part II we follow a similar pattern, but we emphas ize reasoning rather than the med ical facts.
  • vVe offer multiple specific, annotated examples of both optimal and faulty clinical reasoning.
  • Using examples t-0 learn concepts has spe- cial benefits.
  • Learning from books or from direct instruction requires little inference or active participation by the learner, whereas learning by discovery from examples requires considerable inference and active engagement.
  • Because of the active involvement, learning by discovery through specific examples may be more likely to "stick."
  • Learning through inference also generates plausible general c:oncepts that, in turn, become useful in future simiilar and related contexts.
  • We have selected the examples for Part II carefull y.
  • Although our selection of clinical mate- rial does not exhaust ively encompass all cognitive concepts, we have tried to choose patient prob- lems that instantiate (exemplify) the specific inferences that we wish the reader to make.
  • We descr ibe a sufficient number of broad examples to evoke, by inference, a large array of appro- pr iate and relevant pr inci pies. However, we have avoided describing only examples of opt imal rea - soning because a reader might well overgeneral ize an inferred concept from such examples.
  • To avo id such overgeneralization, we a lso furnish negative examples: In this context, negative examples are instances of faulty clinical reasoning. Such coun- terexamples are helpful in circumscribing the con- cepts that we want to teach. Counterexamples that are "near misses," namely, negative examples that just miss being positi ve by a small number of at- tributes, may be particularly helpful in elaborating on a reasoning strategy. Each case covers a small fragment of the broad range of reasoning processes used in clinical nnedicine. Because knowledge of mental processes is at best [[incomplete]] and at worst fi lled with mis- steps and blind alleys, we should exerc ise caution in being too confident that we fully understand these complex processes. Nonetheless, we be lieve that the issues, pr inci pies, and concepts we consider provide a unique framework for both learning and teaching clinical reasoning.